Failed early pregnancy

Dr Matt Adams and Dr Jeremy Jones et al.

Failed early pregnancy refers to the death of the embryo and therefore, miscarriage. The most common cause of embryonic death is a chromosomal abnormality.

  • crown-rump length (CRL) of ≥7 mm and no heartbeat on a transvaginal scan
  • mean sac diameter (MSD) of ≥25 mm and no embryo on a transvaginal scan
  • absence of embryo with heartbeat ≥2 weeks after a scan that showed a gestational sac without a yolk sac
  • absence of embryo with heartbeat ≥11 days after a scan that showed a gestational sac with a yolk sac
  • pregnancy with an embryo with no heart activity on initial scan and repeat scan ≥7 days later 2
  • sac with no embryo and an MSD <12 mm on initial scan that fails to double in size on a scan ≥14 days later 2
  • sac with no embryo and an MSD ≥12 mm on initial scan with no embryo heart activity on a scan ≥7 days later 2
  • embryo (irrespective of crown-rump length) without cardiac activity on initial scan and a scan ≥7 days later 2
  • crown-rump length (CRL) of <7 mm and no heartbeat
  • mean sac diameter (MSD) of 16-24 mm and no embryo
  • absence of embryo with heartbeat 7-13 days after a scan that showed a gestational sac without a yolk sac
  • absence of embryo with heartbeat 7-10 days after a scan that showed a gestational sac with a yolk sac
  • absence of embryo ≥ 6 weeks after last menstrual period
  • amnion seen adjacent to yolk sac, with no visible embryo (empty amnion sign)
  • enlarged yolk sac (>7 mm)
  • small gestational sac in relation to the size of the embryo (<5 mm difference between mean sac diameter and crown-rump length)
  • large amniotic cavity (expanded amnion sign)

When there are findings suspicious for pregnancy failure, follow-up ultrasonography at 7-14 days to assess the pregnancy for viability is generally appropriate.

Ultrasound - obstetric
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Article information

rID: 9040
System: Obstetrics
Section: Gamuts
Synonyms or Alternate Spellings:
  • Embryonal death
  • Embryonic death
  • Embryonic demise
  • Embryonal demise
  • Non-viable early pregnancy
  • Failed early gestation
  • Non viable early gestation

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Cases and figures

  • Case 1: with absent fetal heart beat
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  • Case 2
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  • Case 3
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